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NPI Code Detail

MEDICARE: KEITH COPPER JR.

MEDICARE: KEITH COPPER JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantA8754NC

General Provider Information

NPI Number : 1689513004
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH COPPER JR.
Provider Business Mailing Address
First Line : 3721 QUEENSWOOD LN
Second Line :
City : JAMESTOWN
State : NC
Zip : 27282-9589
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 109 PENNY RD
Second Line :
City : HIGH POINT
State : NC
Zip : 27260-2500
Country : US
Telephone Number : 336-821-4050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2026
Last Update Date : 03/28/2026

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